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Abstract

Although most patients who have prosthetic replacement of diseased heart valves have significant symptomatic improvement after surgery, it has become apparent that a small percentage either becomes worse or fails to improve. Awareness of the causes of a poor surgical result and objective evidence that there has not been improvement can be helpful in correct diagnosis and management. The objective distinction between a good and poor surgical result may be difficult, however, because patients considered to have satisfactory relief of symptoms do not necessarily improve to a normal state as defined by the usual clinical or hemodynamic criteria. In addition,